Incidence of Local and Port Site Recurrence of Urologic Cancer After Laparoscopic Surgery

Abstract

To determine the incidence of dissemination and port site metastases in patients undergoing laparoscopic surgery for urologic cancer. From June 1992 to August 2005, 459 laparoscopic procedures were performed, 304 of which were for cancer. These included 162 radical prostatectomies, 67 radical nephrectomies, 20 partial nephrectomies, 45 nephroureterectomies, 5 retroperitoneal lymph node dissections of testicular cancers after chemotherapy, 3 radical cystectomies, and 2 other procedures. No patients without a histologic diagnosis of cancer were included in this study. Of the 304 patients with cancer, 4 (1.3%) developed a local recurrence, including after retroperitoneal lymph node dissection in 2 patients, radical nephrectomy in 1, and radical cystectomy in 1. No port site metastases were observed. The histologic type of both testicular cancers was mixed germ cell tumor, with one occurring in a renal hilar lymph node and the other in a paraaortic lymph node and kidney. The histologic type of the renal cell carcinoma was papillary renal cell carcinoma with sarcomatoid features (Stage pT3aN1), and it occurred in a retrocaval lymph node. The histologic type of the bladder cancer was transitional cell carcinoma, Grade 3, Stage pT4aN0, and it presented as peritoneal carcinomatosis 11 months postoperatively. The incidence of recurrence in our series was closely correlated with the range in previous reports. However, two recurrences were found in 5 patients who had undergone retroperitoneal lymph node dissection for testicular cancer after chemotherapy. Therefore, we should be careful when determining the indications for laparoscopic surgery in such patients.